City of El Monte Rapid Re-Housing Program Application

APPLICANT INFORMATION

BACKGROUND INFORMATION

Please provide requested information for all household members, EXCLUDING yourself.

Household Member #1
Household Member #2
Household Member #3
Household Member #4
Household Member #5
Household Member #6

I understand and by signing agree that all information I have provided in this application is true and correct to the best of my knowledge. I agree to notify you promptly in writing upon any material change in the information provided herein. You are authorized to make such inquiries, as you deem necessary and appropriate to verify the accuracy of this application.

The information supplied is used strictly for establishing eligibility for the El Monte Rapid Re-housing Program under SGVCOG funds. Applicant(s) acknowledge that personal and financial information may be subject to public disclosure under the California Public Records Act. If chosen for funding, applicant will be required to provide financial documentation, including but not limited to tax returns, paystubs, EDD information, copy of lease or rental agreement, letter from employer stating reduction of hours or job loss, and/or other applicable documentation.

DISCLAIMER: The submittal of information herein does not guarantee any award of funding from the City of El Monte or constitute a financial commitment thereof. Grant funds are subject to applicable funding limitations and the City of El Monte’s verification of various eligibility requirements. The information provided on this form is subject to verification by the SGVCOG at any time, and Title 18, Section 1001 of the U.S. Code which states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making false or fraudulent statement to the Department of the United Stated Government.